Building the health information infrastructure for the modern epatient

Dr. Farzad Mostashari on how the web, data and epatients are poised to revolutionize healthcare.

To learn more about what levers the government is pulling to catalyze innovation in the healthcare system, I turned to Dr. Farzad Mostashari (@Farzad_ONC). As the National Coordinator for Health IT, Mostashari is one of the most important public officials entrusted with improving the nation’s healthcare system through smarter use of technology.

Mostashari, a public-health informatics specialist, was named ONC chief in April 2011, replacing Dr. David Blumenthal. Mostashari’s full biography, available at HHS.gov, notes that he “was one of the lead investigators in the outbreaks of West Nile Virus and anthrax in New York City, and was among the first developers of real-time electronic disease surveillance systems nationwide.”

What excites you about your work? What trends matter here?

Farzad Mostashari‏: Well, it’s a really fun job. It feels like this is the ideal time for this health IT revolution to tie into other massive megatrends that are happening around consumer and patient empowerment, payment and delivery reform, as I talked about in my TED Med Talk with Aneesh Chopra.

These three streams [how patients are cared for, how care is paid for, and how people take care of their own health] coming together feels great. And it really feels like we’re making amazing progress.

How does what’s happening today grow out of the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH) Act in 2009?

Farzad Mostashari‏: HITECH was a key part of ARRA, the American Recovery and Reinvestment Act. This is the reinvestment part. People think of roadways and runways and railways. This is the information infrastructure for healthcare.

In the past two years, we made as much progress on adoption as we had made in the past 20 years before that. We doubled the adoption of electronic health records in physician offices between the time the stimulus passed and now. What that says is that a large number of barriers have been addressed, including the financial barriers that are addressed by the health IT incentive payments.

It also, I think, points to the innovation that’s happening in the health IT marketplace, with more products that people want to buy and want to use, and an explosion in the number of options people have.

The programs we put in place, like the Regional Health IT Extension Centers modeled after the Agriculture Extension program, give a helping hand. There are local nonprofits throughout the country that are working with one-third of all primary care providers in this country to help them adopt electronic health records, particularly smaller practices and maybe health centers, critical access hospitals and so forth.

This is obviously a big lift and a big change for medicine. It moves at what Jay Walker called "med speed," not tech speed. The pace of transformation in medicine that’s happening right now may be unparalleled. It’s a good thing.

Healthcare providers have a number of options as they adopt electronic health records. How do you think about the choice between open source versus proprietary options?

Farzad Mostashari‏: We’re pretty agnostic in terms of the technology and the business model. What matters are the outcomes. We’ve really left the decisions about what technology to use to the people who have to live with it, like the doctors and hospitals who make the purchases.

There are definitely some very successful models, not only on the EHR side, but also on the health information exchange side.

(Note: For more on this subject, read Brian Ahier’s Radar post on the Health Internet.)

What role do open standards play in the future of healthcare?

Farzad Mostashari‏: We are passionate believers in open standards. We think that everybody should be using them. We’ve gotten really great participation by vendors of open source and proprietary software, in terms of participating in an open standards development process.

I think what we’ve enabled, through things like modular certification, is a lot more innovation. Different pieces of the entire ecosystem could be done through reducing the barrier to entry, enabling a variety of different innovative startups to come to the field. What we’re seeing is, a lot of the time, this is migrating from installed software to web services.

If we’re setting up a reference implementation of the standards, like the Connect software or popHealth, we do it through a process where the result is open source. I think the government as a platform approach at the Veterans Affairs department, DoD, and so forth is tremendously important.

How is the mobile revolution changing healthcare?

We had Jay Walker talking about big change [at a recent ONC Grantee Meeting]. I just have this indelible image of him waving in his left hand a clay cone with cuneiform on it that is from 2,000 B.C. — 4,000 years ago — and in his right hand he held his iPhone.

He was saying both of them represented the cutting edge of technology that evolved to meet consumer need. His strong assertion was that this is absolutely going to revolutionize what happens in medicine at tech speed. Again, not "med speed."

I had the experience of being at my clinic, where I get care, and the pharmacist sitting in the starched, white coat behind the counter telling me that I should take this medicine at night.

And I said, “Well, it’s easier for me to take it in the morning.” And he said, “Well, it works better at night.”

And I asked, acting as an empowered patient, “Well, what’s the half life?” And he answered, “Okay. Let me look it up.”

He started clacking away at his pharmacy information system; clickity clack, clickity clack. I can’t see what he’s doing. And then he says, “Ah hell,” and he pulls out his smartphone and Googles it.

There’s now a democratization of information and information tools, where we’re pushing the analytics to the cloud. Being able to put that in the hand of not just every doctor or every healthcare provider but every patient is absolutely going to be that third strand of the DNA, putting us on the right path for getting healthcare that results in health.

We’re making sure that people know they have a right to get their own data, making sure that the policies are aligned with that. We’re making sure that we make it easy for doctors to give patients their own information through things like the Direct Project, the Blue Button, meaningful use requirements, or the Consumer E-Health Pledge.

We have more than 250 organizations that collectively hold data for 100 million Americans that pledge to make it easy for people to get electronic copies of their own data.

Do you think people will take ownership of their personal health data and engage in what Susannah Fox has described as “peer-to-peer healthcare”?

Farzad Mostashari‏: I think that it will be not just possible, not even just okay, but actually encouraged for patients to be engaged in their care as partners. Let the epatient help. I think we’re going to see that emerging as there’s more access and more tools for people to do stuff with their data once they get it through things like the health data initiative. We’re also beginning to work with stakeholder groups, like Consumer’s Union, the American Nurses Association and some of the disease groups, to change attitudes around it being okay to ask for your own records.

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